BACKGROUND: Sentinel node and occult lesion localization (SNOLL) calls for a combination of two specific procedures: intraoperative detection of sentinel lymph node (SLN) and radio-­guided occult lesion localization (ROLL). The safety and benefits of radio-­guided localization in the surgical treatment of non-­palpable breast cancer have been confirmed. The aim of this study was to evaluate the potential role for an intra-­operative handheld gamma camera (TreCam) in the SNOLL procedure.METHODS: Fifteen patients were enrolled. The SNOLL procedure was performed in all patients with conventional lymphoscintigraphy (LS). TReCam was used to obtain nuclear imaging in the operating theater. Concordance between LS and TreCam images, duration of use and assessment of difficulties in data acquisition with TReCam were reported.RESULTS: Concordance for tumor localization between single-­detector gamma probe and TReCam was excellent (15/15). The number of radioactive SLNs visualized between LS and TReCam was equivalent in 53.3% of cases (8/15). TreCam was considered to be very easy-­to-­use (12/15) or easy-­to-­use (3/15). Average duration of acquisition with TReCam was 4 min 45 s for the SLN procedure and 2 min 10 s for lumpectomy.CONCLUSION: This study suggests that TReCam is easy-­to-­use and does not increase operative time. Its exact role in radio-­guided surgery needs to be clearly defined in a larger study. However, its usefulness and benefits in radio-­guided breast surgery seem to be promising.